Systems and methods for treating conditions and diseases of the spine

ABSTRACT

Systems and methods for treating conditions and diseases of the spine are disclosed herein. A device includes a balloon catheter comprising at least one inner lumen incorporated within an elongated shaft; a distal end having an inner balloon positioned inside and completely surrounded by an outer balloon; and a proximal end having an adapter for passage of at least one of an inflation fluid or a medical instrument; and an optical fiber comprising an outer diameter sized to pass through the inner lumen of the elongated shaft; a nonlinear light-emitting portion of a given length, wherein a portion of a cladding material from the nonlinear light-emitting portion has been removed so that light energy may be emitted along the length of the nonlinear light-emitting portion; and a linear elongated portion for guiding light towards the nonlinear light-emitting portion.

RELATED APPLICATIONS

This application is a continuation application of U.S. application Ser.No. 15/834,459, filed Dec. 7, 2017, which is a continuation applicationof U.S. application Ser. No. 14/874,946, filed Oct. 5, 2015, now U.S.Pat. No. 9,855,080, which is a continuation application of U.S.application Ser. No. 13/335,110, filed Dec. 22, 2011, now U.S. Pat. No.9,179,959, which claims the benefit of and priority to U.S. ProvisionalApplication No. 61/426,044, filed on Dec. 22, 2010, these applicationsare hereby incorporated herein by reference in their entireties.

FIELD

The embodiments disclosed herein relate to medical devices, and moreparticularly to systems and methods for treating conditions and diseasesof the spine.

BACKGROUND

Degenerative disc disease (DDD) of the spine is one of the most commoncauses of lower back pain. The discs and the facet joints are consideredthe motion segments of the vertebral columns; the discs also act asshock absorbers between the vertebral bodies. Two prevalent causes ofdegenerative disc disease are increased thinning of the disc due to age,and thinning due to injury, for instance when the vertebral endplatetears from its connection to the intervertebral disc. Disc replacementgoals include eliminating pain, sustaining range of motion, protectingadjacent spine segments, reducing morbidity and restoration of discheight.

Vertebral compression fractures are a common spinal injury. Suchfractures happen when a vertebra collapses or is fractured due to traumaor due to a weakened vertebra in patients with osteoporosis, certaintypes of cancer or osteogenesis imperfecta, for example. When thevertebra collapses, the bone tissue on the inside is crushed orcompressed, which can cause pain and spinal deformity. Vertebralcompression fractures, if left untreated, may result in long termdisability. Treatment goals include eliminating pain and restoration ofdisc height.

SUMMARY

Systems and methods for treating conditions and diseases of the spineare disclosed herein. According to aspects illustrated herein, there isprovided a device that includes a balloon catheter having an elongatedshaft with a proximal end, a distal end, and a longitudinal axistherebetween, the balloon catheter comprising at least one inner lumenincorporated within the elongated shaft; an inner balloon positionedinside and completely surrounded by an outer balloon, the balloonslocated at the distal end; and an adapter for passage of at least one ofan inflation fluid or a medical instrument, the adapter located at theproximal end; and an optical fiber having a core surrounded by acladding material, the optical fiber comprising an outer diameter sizedto pass through the inner lumen of the elongated shaft of the ballooncatheter; a nonlinear light-emitting portion of a given length, whereina portion of the cladding material from the nonlinear light-emittingportion has been removed so that light energy may be emitted along thelength of the nonlinear light-emitting portion; and a linear elongatedportion for guiding light towards the nonlinear light-emitting portion.

According to aspects illustrated herein, there is provided a device thatincludes a balloon catheter having an elongated shaft with a proximalend, a distal end, and a longitudinal axis therebetween; an expandablemember releasably disposed at a distal end of the balloon catheter, theexpandable member comprising an outer balloon and one or more innerballoons; and an optical fiber having a pre-shaped distal portion,wherein the balloon catheter includes a plurality of inner lumens influid communication with a plurality of inner cavities within theexpandable member for passing the optical fiber, an inflation fluid, anda light-sensitive fluid to the plurality of inner cavities within theexpandable member, and wherein the optical fiber is configured to emitlight along at least a part of the pre-shaped distal portion of theoptical fiber.

According to aspects illustrated herein, there is provided a system thatincludes a balloon catheter having an elongated shaft with a proximalend, a distal end, and a longitudinal axis therebetween, the ballooncatheter comprising at least one inner lumen incorporated within theelongated shaft; at least a first inner inflatable balloon positionedinside and completely surrounded by an outer inflatable balloon, theballoons located at the distal end; and an adapter for passage of atleast one of an inflation fluid or a medical instrument, the adapterlocated at the proximal end; an optical fiber having a core surroundedby a cladding material, the optical fiber comprising an outer diametersized to pass through the inner lumen of the elongated shaft of theballoon catheter; a nonlinear light-emitting portion of a given length,wherein a portion of the cladding material from the nonlinearlight-emitting portion has been removed so that light energy may beemitted along the length of the nonlinear light-emitting portion; alinear elongated portion for guiding light towards the nonlinearlight-emitting portion; a relaxed condition in which the nonlinearlight-emitting portion of the optical fiber assumes a curvedconformation; a stretched condition in which the nonlinearlight-emitting portion of the optical fiber has a linear conformation inwhich the nonlinear light-emitting portion of the optical fiber can beadvanced through the inner lumen of the elongated shaft of the ballooncatheter; and a memory which returns the nonlinear light-emittingportion from the stretched condition to the relaxed condition; alight-sensitive fluid; and a light source.

According to aspects illustrated herein, there is provided a method forrepairing a vertebral compression fracture that includes gaining accessto a collapsed vertebrae; delivering to the collapsed vertebrae, in anunexpanded state, an expandable member having a inner balloon positionedinside and completely surrounded by an outer balloon; injecting aninflation fluid into the outer balloon to expand the outer balloon andto temporarily restore height of the collapsed vertebrae; maintainingthe expanded outer balloon while injecting a light-sensitive fluid intothe inner balloon to expand the inner balloon within the expanded outerballoon; positioning an optical fiber sufficiently designed to emitlight energy along a length of the optical fiber inside the expandablemember, wherein the optical fiber is connected to a light source;activating the light source; delivering light energy to the opticalfiber from the light source; and curing the light-sensitive fluid insidethe inner balloon to harden the inner balloon within the expanded outerballoon.

According to aspects illustrated herein, there is provided a method forrepairing a vertebral compression fracture that includes positioning anexpandable member releasably disposed at a distal end of a ballooncatheter within a cancellous bone region of a fractured or collapsedvertebra, wherein the expandable member comprises an outer balloon andone or more inner balloons; moving the outer balloon from a deflatedstate to an inflated state to expand the collapsed or fractured vertebrato a desired height; moving one or more inner balloons from a deflatedstate to an inflated state with a light-sensitive fluid; introducing apre-shaped optical fiber into an inner cavity within the outer balloon;activating the optical fiber to uniformly cure the light-sensitive fluidwithin the one or more inner balloons; moving the outer balloon from theinflated state to the deflated state; and releasing the expandablemember from the balloon catheter.

According to aspects illustrated herein, there is provided a method forreplacing a degenerative disc that includes removing a degenerative discto create a space; delivering to the space, in an unexpanded state, anexpandable member having at least a first inner balloon positionedinside and completely surrounded by an outer balloon; injecting aninflation fluid into the outer balloon to expand the outer balloon andto temporarily restore native disc height; maintaining the expandedouter balloon while injecting a light-curable fluid into the first innerballoon to expand the first inner balloon within the expanded outerballoon; positioning an optical fiber sufficiently designed to emitlight energy along a length of the optical fiber inside the expandablemember, wherein the optical fiber is connected to a light source;activating the light source; delivering light energy to the opticalfiber from the light source; and curing the light-curable fluid insidethe first inner balloon to harden the first inner balloon within theexpanded outer balloon.

BRIEF DESCRIPTION OF THE DRAWINGS

The presently disclosed embodiments will be further explained withreference to the attached drawings, wherein like structures are referredto by like numerals throughout the several views. The drawings shown arenot necessarily to scale, with emphasis instead generally being placedupon illustrating the principles of the presently disclosed embodiments.

FIG. 1 is a schematic illustration showing various components of anembodiment of a system of the present disclosure;

FIG. 2 is a side view of an embodiment of a proximal end of a ballooncatheter of the present disclosure;

FIG. 3 is a side view of an embodiment of a distal end of a ballooncatheter of the present disclosure;

FIG. 4A and FIG. 4B are cross-sectional views of embodiments ofexpandable members of a balloon catheter of the present disclosure;

FIG. 5 shows an embodiment of an optical fiber of the present disclosurein an elongated stretched condition and being in a “temporary” shape;

FIG. 6 shows an embodiment of a nonlinear light-emitting portion of anoptical fiber of the present disclosure in a relaxed condition and beingin an “original”, “pre-shaped” or “permanent” shape;

FIG. 7 shows an embodiment of a nonlinear light-emitting portion of anoptical fiber of the present disclosure in a relaxed condition and beingin an “original”, “pre-shaped” or “permanent” shape;

FIG. 8 shows an embodiment of a nonlinear light-emitting portion of anoptical fiber of the present disclosure in a relaxed condition and beingin an “original”, “pre-shaped” or “permanent” shape;

FIG. 9 shows an embodiment of a nonlinear light-emitting portion of anoptical fiber of the present disclosure in a relaxed condition and beingin an “original”, “pre-shaped” or “permanent” shape;

FIG. 10 shows a close-up view of an embodiment of a distal end of aballoon catheter of the present disclosure;

FIG. 11 shows a close-up view of an embodiment of a distal end of aballoon catheter of the present disclosure;

FIG. 12 shows a close-up view of an embodiment of a distal end of aballoon catheter of the present disclosure;

FIG. 13 shows a close-up view of an embodiment of a distal end of aballoon catheter of the present disclosure;

FIGS. 14A-14E show an embodiment of method steps for repairing avertebral compression fracture using components of the presentdisclosure; and

FIGS. 15A-15E show an embodiment of method steps for replacing adegenerative disc using components of the present disclosure.

While the above-identified drawings set forth presently disclosedembodiments, other embodiments are also contemplated, as noted in thediscussion. This disclosure presents illustrative embodiments by way ofrepresentation and not limitation. Numerous other modifications andembodiments can be devised by those skilled in the art which fall withinthe scope and spirit of the principles of the presently disclosedembodiments.

DETAILED DESCRIPTION

A medical device disclosed herein may be used for treating conditionsand diseases of the spine, including, but not limited to, vertebralcompression fractures (repairing bones) and degenerative disc disease(repairing soft tissue) resulting from osteoporosis, pressure on thespine, metastatic disease, or a fall or other type of injury. Althoughthe medical devices disclosed herein are contemplated to be used fortreating such spine conditions and diseases, those skilled in the artwill recognize that the disclosed devices and methods may be used forrepairing other bones including, but not limited to, the femur, tibia,fibula, humerus, ulna, radius, metatarsals, phalanx, phalanges, ribs,spine, vertebrae, clavicle and other bones and still be within the scopeand spirit of the disclosed embodiments.

FIG. 1 is a schematic illustration showing various components of anembodiment of a system 100 of the present disclosure. System 100includes a light source 108, a light pipe 120, an attachment system 130and a light-conducting optical fiber 106 having a nonlinearlight-emitting portion 158, which emits light from the outside of theoptical fiber 106 along its length. The attachment system 130communicates light energy from the light source 108 to the optical fiber106. In an embodiment, the light source 108 emits frequency thatcorresponds to a band in the vicinity of 390 nm to 770 nm, the visiblespectrum. In an embodiment, the light source 108 emits frequency thatcorresponds to a band in the vicinity of 410 nm to 500 nm. In anembodiment, the light source 108 emits frequency that corresponds to aband in the vicinity of 430 nm to 450 nm. The optical fiber 106 can bemade from any material, such as glass, silicon, silica glass, quartz,sapphire, plastic, combinations of materials, or any other material, andmay have any diameter. In an embodiment, the optical fiber 106 is madefrom a polymethyl methacrylate core with a transparent polymer cladding.It should be noted that the term “optical fiber” is not intended to belimited to a single optical fiber, but may also refer to multipleoptical fibers as well as other means for communicating light from thelight source to the expandable member.

System 100 further includes a balloon catheter 110 having an elongatedshaft 101 with a proximal end 102, a distal end 104, and a longitudinalaxis therebetween. In an embodiment, the balloon catheter 110 has anoutside diameter ranging from about 3 mm (9 French) to about 8 mm (24French). In an embodiment, the balloon catheter 110 may have an outsidediameter of about 3 mm (9 French). At least one inner lumen isincorporated within the elongated shaft 101 of the balloon catheter 110.In an embodiment, the elongated shaft 101 of the balloon catheter 110includes two inner lumens. In an embodiment, the elongated shaft 101 ofthe balloon catheter 110 includes three inner lumens. The proximal end102 of the balloon catheter 110 includes an adapter for passage of atleast one of inflation fluids or medical instruments, as will bedescribed with respect to FIG. 2. The distal end 104 of the ballooncatheter 110 includes at least a first inner inflatable balloonpositioned inside and completely surrounded by an outer inflatableballoon, and is generally shown as expandable member 103. In anembodiment, the expandable member 103 is manufactured from anon-compliant (non-stretch/non-expansion) conformable material. In anembodiment, the expandable member 103 is manufactured from a conformablecompliant material that is limited in dimensional change by embeddedfibers. One or more radiopaque markers, bands or beads may be placed atvarious locations along the expandable member 103 and/or the ballooncatheter 110 so that components of the system 100 may be viewed usingfluoroscopy.

FIG. 2 is a side view of an embodiment of a proximal end of a ballooncatheter of the present disclosure. Referring to FIG. 2, in anembodiment, the proximal end 102 of the balloon catheter 110 may includea multipurpose adapter having multiple ports 115, 125, and 135configured to accept inflation fluids or medical instruments to bedelivered through the balloon catheter 110 towards (and/or into) theexpandable member 103. In an embodiment, a manifold may be provided thatcan be connected to a port, the manifold including multiple ports andindicia to remind a user which one of the balloons is controlled throughwhich port. One of the ports can accept, for example, the optical fiber106. The other port can accept, for example, a syringe 160 housing alight-sensitive fluid (see, for example, FIG. 1). In an embodiment, thesyringe 160 maintains a low pressure during the infusion and aspirationof the light-sensitive fluid. In an embodiment, the syringe 160maintains a low pressure of about 10 atmospheres or less during theinfusion and aspiration of the light-sensitive fluid.

Expandable Member

The distal end of the balloon catheter includes an expandable memberhaving at least a first inflatable balloon positioned inside andcompletely surrounded by an outer inflatable balloon. In an embodiment,the external surface of any of the balloons is resilient and punctureresistant. In an embodiment, the external surface of any of the balloonsis free of pores and does not allow for inflation fluid to escape fromthe balloon. In an embodiment, a balloon of the present disclosure is ahigh-pressure balloon molded to an inflated geometry from noncompliantor low-compliant materials that retain their designed size and shapeeven under high pressure. In an embodiment, a balloon of the presentdisclosure is thin walled and exhibits high tensile strength, withrelatively low elongation. In an embodiment, because an outer inflatableballoon may need to be pressurized to a higher pressure than an innerinflatable balloon, the outer inflatable balloon may have a thicker walland/or be made of stronger material than the inner inflatableballoon(s). In an embodiment, the balloons are manufactured from anon-compliant (non-stretch/non-expansion) conformable material includingbut not limited to urethane, polyethylene terephthalate (PET), nylonelastomer and other similar polymers. In an embodiment, the balloons aremanufactured from a polyethylene terephthalate (PET) and are opticallyclear and can transmit light over a broad spectrum. In an embodiment,the balloons of the present disclosure have a size ranging from about0.5 to about 50 mm in diameter in virtually any working length. In anembodiment, the balloons are manufactured from a radiolucent material,which permit x-rays to pass through the balloons. In an embodiment, theballoons are manufactured from a radiolucent polyethylene terephthalate(PET). In an embodiment, the balloons are manufactured from aconformable compliant material that is limited in dimensional change byembedded fibers.

One or more radiopaque markers or bands may be placed at variouslocations along one or more balloons of the plurality of the balloons. Aradiopaque ink bead may be placed at the distal end of the expandablemember for alignment of the balloon catheter and/or the expandablemember during fluoroscopy. The one or more radiopaque bands, usingradiopaque materials such as barium sulfate, tantalum, or othermaterials known to increase radiopacity, may allow a medicalprofessional to view the balloon catheter and/or the expandable memberusing fluoroscopy techniques. The one or more radiopaque bands may alsoprovide visibility during inflation of the balloons of the expandablemember to determine the precise positioning of the balloons and thedevice during placement and inflation. The one or more radiopaque bandsmay also permit visualization of any voids that may be created by airthat gets entrapped in the balloons.

In an embodiment, at least a portion of the external surface of aballoon is substantially even and smooth. Alternatively or additionally,in an embodiment, an outer surface of a balloon may be textured orroughened to further promote tissue adhesion to the expandable member.In an embodiment, at least a portion of the external surface of theballoon includes at least one textured element such as a bump, a ridge,a rib, an indentation or any other shape. In an embodiment, the texturedelement may enhance the attachment of bone, cell, or tissue to theballoon. In an embodiment, at least a portion of the external surface ofthe balloon protrudes out to form a textured element. In an embodiment,at least a portion of the external surface of the balloon invaginates toform a textured element. In an embodiment, the textured elementincreases the friction and improves the grip and stability of theballoon after the balloon is inserted. In an embodiment, the texturedelement results in increased interdigitation of bone-device interface ascompared to a balloon without textured elements. In an embodiment, thetextured element can be convex in shape. In an embodiment, the texturedelement can be concave in shape. In an embodiment, the textured elementcan be circumferential around the width of the balloon, eithercompletely or partially.

In general, bone graft or bone graft substitute can be used inconjunction with a balloon of the present disclosure. In an embodiment,the bone graft is an allogeneic bone graft. In an embodiment, the bonegraft is an autologous bone graft. In an embodiment, the bone graftsubstitute is a hydroxyapatite bone substitute. In an embodiment, a bonegraft or bone graft substitute is used to fill in any gaps that mayexist, for example, between the external surface of the balloon and thesurfaces of the bone fragments. In an embodiment, a bone graft or bonegraft substitute is used to fill any gaps that may exist, for example,between the textured element of the balloon and the surfaces of the bonefragments.

In general, a balloon can include an external surface that may be coatedwith materials including, but not limited to, drugs (for example,antibiotics), proteins (for example, growth factors) or other natural orsynthetic additives (for example, radiopaque or ultrasonically activematerials). For example, after a minimally invasive surgical procedurean infection may develop in a patient, requiring the patient to undergoantibiotic treatment. An antibiotic drug may be added to the externalsurface of a balloon to prevent or combat a possible infection.Proteins, such as, for example, bone morphogenic protein or other growthfactors have been shown to induce the formation of cartilage and bone. Agrowth factor may be added to the external surface of a balloon to helpinduce the formation of new bone. Due to the lack of thermal egress ofthe light-sensitive liquid monomer in a balloon, the effectiveness andstability of the coating is maintained.

In an embodiment, at least one bearing surface of a balloon may becovered with a biocompatible material. In an embodiment, thebiocompatible material may be an expanded biocompatible material such aspolytetrafluoroethylene (PTFE). The biocompatible material may provideboth a surface and a compressive material that can absorb any abrasivecontact with sharpened surfaces of a bone to be stabilized. In anembodiment, at least one bearing surface of a balloon may be coveredwith a thickened PTFE capable of transiting sharp surfaces andmodulating them into curves that would not be potentially disruptive tothe plurality of balloons.

In general, a balloon typically does not have any valves. One benefit ofhaving no valves is that the balloon may be expanded or reduced in sizeas many times as necessary to assist in the fracture reduction andplacement. Another benefit of the balloon having no valves is theefficacy and safety of the system. Since there is no communicationpassage of light-sensitive liquid monomer to the body there cannot beany leakage of liquid monomer because all the liquid monomer iscontained within the balloon. In an embodiment, a permanent seal iscreated between the balloon and the balloon catheter that is bothhardened and affixed prior to the balloon catheter being removed.

In an embodiment, abrasively treating the external surface of a balloonfor example, by chemical etching or air propelled abrasive media,improves the connection and adhesion between the external surface of theballoon and a bone surface. The surfacing significantly increases theamount of surface area that comes in contact with the bone which canresult in a stronger grip.

In general, a balloon of the present disclosure can include any of thefeatures described above, with modification to some or all of thefeatures.

FIG. 3 is a side view of an embodiment of a distal end 104 of a ballooncatheter 110 of the present disclosure. The distal end 104 of theballoon catheter 110 terminates in an expandable member 103 comprisingat least two balloons. In an embodiment, the at least two balloons areconcentric relative to one another. The expandable member 103 comprisesan outer expandable balloon 201 and one or more inner expandableballoons 203 and 205. For the sake of clarity, the balloon 203 may bereferred to herein as the inmost inner balloon 203 and the balloon 205may be referred to herein as the intermediate inner balloon 205. Itshould be understood that although the device illustrated in FIG. 3includes two inner balloons 203 and 205, a device of the presentdisclosure may alternatively include only one inner balloon (asillustrated, for example, in FIG. 10, FIG. 11, FIG. 12 and FIG. 13) ormore than two inner balloons as desired. Each balloon may be moved froma deflated state to an inflated state, as will be described below,independently of other balloons. It should be noted that operating,i.e., inflating or deflating, one or more of the inner balloons may alsoat least partially operate other balloons, especially balloons that areouter to the balloon being operated.

In an embodiment, one or more of the inner balloons may include apressure relief valve. In operation, if the pressure inside a balloonhaving a pressure relief valve exceeds a pre-established limit, such asdue to the user's error or the patient's movement, the pressure reliefvalve may release some of the fluid in the balloon into an adjacentballoon to decrease the pressure below the pre-established limit.

In an embodiment, each balloon may be a specific shape demanded, forexample, by the anatomical site including, but not limited to, round,flat, cylindrical, dog bone, tapered, oval, conical, spherical, square,rectangular, toroidal and combinations thereof, independently of otherballoons. Each balloon may be positioned in any orientation relative tothe catheter, independently of other balloons.

In an embodiment, a separation area is located at the junction betweenthe expandable member and the balloon catheter. The separation area mayhave a stress concentrator. The stress concentrator may be a notch,groove, channel or similar structure that concentrates stress in theseparation area. The stress concentrator of the separation area may benotched, scored, indented, pre-weakened or pre-stressed to directseparation of the expandable member from the elongated shaft of theballoon catheter under specific torsional and/or tension load. Theseparation area ensures that there are no leaks of the light-sensitivefluid from the balloon catheter and/or the expandable member. Theseparation area seals the expandable member and removes the ballooncatheter by making a break at a known or predetermined site (e.g., aseparation area). The separation area may be various lengths and up toabout an inch long. In an embodiment, when torque (twisting) is appliedto the balloon catheter the elongated shaft of the balloon catheterseparates from the expandable member. The twisting creates a sufficientshear to break the residual hardened light-sensitive liquid monomer (nowa polymer) and create a clean separation of the expandablemember/balloon catheter interface. In an embodiment, the expandablemember may be separated from the balloon catheter using a separationinstrument. The separation area may have a defined position for aseparation instrument to engage the balloon catheter. The position ofthe separation area on the balloon catheter may not only be marked andidentified by a radiopaque marker band, but there may be a physical stepin the balloon catheter to provide both a tactile and audible feel andsound to the user to identify the delivery and positioning of theseparation tool. The combination of these two aspects may decrease thedependence of fluoroscopy imaging and exposure to both the patient andthe surgeon. In yet another embodiment, the expandable member may be cutfrom the balloon catheter using a cutting device.

In an embodiment, at least one of the balloons may be toroidal in shape,with the walls of the balloon defining an inner cavity within theballoon. For example, FIG. 4A is a cross-sectional view of an embodimentof the expandable member 103 comprising an outer balloon 201 having atoroidal shape, and intermediate inner balloon 205 and inmost innerballoon 203 having an oval shape. In the embodiment shown in FIG. 4A,the outer balloon 201 is in a vertical orientation, i.e., with flatsides forming the top and bottom surfaces of the outer balloon 201. Itshould be understood, however, that the outer balloon 201 could also bepositioned in a horizontal orientation, i.e., with flat sides formingthe proximal and distal surfaces of the outer balloon 201. In anembodiment, the outer balloon 201 and the inner balloons 203 and 205each are in fluid communication with an inflation fluid orlight-sensitive fluid by virtue of an inner lumen of the ballooncatheter 110. In an embodiment, the outer balloon 201 is in fluidcommunication with an inflation fluid or light-sensitive fluid 165 thatis distinct from an inner lumen of the balloon catheter 110. An outmostinner cavity 219 is defined by inner surfaces 207 and 209 of the outerballoon 201. An intermediate inner cavity 221 may be formed between aninner surface 217 of the intermediate inner balloon 205 and an outersurface 211 of the inmost inner balloon 203. An inmost inner cavity 223may defined by an inner surface 215 of the inner balloon 203. In anembodiment, the intermediate inner balloon 205 may serve as a protectivebarrier to contain the polymerized light-sensitive fluid within theinmost inner balloon 203 in case the inmost inner balloon 203 rupturesor leaks. Additionally or alternatively, a seal may be provided over thecentral hole of the toroidal outer balloon 201 to provide furtherprotection in case the inmost inner balloon 203 having thelight-sensitive fluid ruptures or leaks.

In an embodiment, a plurality of inner cavities may be defined by theplurality of balloons of the expandable member 103. For example, FIG. 4Bis a cross-sectional view of an embodiment of an expandable member 103comprising an outer balloon 201, an inmost inner balloon 203, and anintermediate inner balloon 205, with the balloons 201, 203, 205 havingan oval shape. An outmost inner cavity 219 may be formed between theinner surface 207 of the outer balloon 201 and an outer surface 213 ofthe intermediate inner balloon 205. Moreover, an intermediate innercavity 221 may be formed between the inner surface 217 of theintermediate inner balloon 205 and the outer surface 211 of the inmostinner balloon 203. Finally, an inmost inner cavity 223 may be defined bythe inner surface 215 of the inmost inner balloon 203. Throughout thespecification, a wall of an inner cavity closest to the outside of theexpandable member 103 will be referred to herein as an outer wall and awall of an inner cavity farthest from the outside of the expandablemember 103 will be referred to herein as an inner wall. For example, inreference to FIG. 3, the outmost inner cavity 219 includes an outer wall201 and an inner wall 205.

Each inner cavity of the plurality of inner cavities is in fluidcommunication with one or more inner lumens incorporated within theelongated shaft of the balloon catheter. A balloon may be moved from adeflated state to an inflated state by injecting an inflation fluid intoone or more inner cavities within the balloon via one or morecorresponding inner lumens. The term “inflation fluid” refers to anyfluid that can be used to expand a balloon to a desired pressure and/orheight. Suitable inflation fluids, include but are not limited to,liquids, such as, water, saline and light-sensitive fluid, or gasses,such as nitrogen and air, or combinations thereof.

In reference to FIG. 3, in an embodiment, the outmost inner cavity 219may be in fluid communication with an outmost lumen 225; theintermediate inner cavity 221 may be in fluid communication with anintermediate lumen 227; and the inmost inner cavity 223 may be incommunication with an inmost lumen 229. In an embodiment, at least oneof the outmost lumen 225, the intermediate lumen 227 or the inmost lumen229 has a diameter ranging from about 1.0 mm to about 4.0 mm. In anembodiment, the outer balloon 201 may be moved from a deflated state toan inflated state by injecting an inflation fluid into the outmost innercavity 219 via the outmost lumen 225. The intermediate inner balloon 205may be moved from a deflated state to an inflated state by injecting aninflation fluid into the intermediate inner cavity 221 via theintermediate lumen 227. The inmost inner balloon 203 may be moved from adeflated state to an inflated state by injecting an inflation fluid intothe inmost inner cavity 223 via the inmost lumen 229. The balloons 201,203, 205 may be moved from an inflated state to a deflated state bywithdrawing an inflation fluid from the inner cavities 219, 223, 221. Itshould be noted that although as illustrated the number of lumenscorrespond to the number of inner cavities, the number of lumens may bemore or fewer than the number of inner cavities. In other words, in anembodiment, a single inner cavity may be in fluid communication withmultiple lumens and/or a single lumen may be in fluid communication withmultiple inner cavities.

In an embodiment, the intermediate inner cavity 221 and the inmostcavity 223 may be filled with the same light-sensitive fluid. In anotherembodiment, the intermediate inner cavity 221 and the inmost cavity 223may be filled with different light-sensitive fluids having differentshore hardness so the inner balloons 203 and 205 may have differentphysical characteristics when the light-sensitive fluid is cured.Accordingly, an implant formed from the expandable member 103 can be alayered implant with layers having different physical characteristics,such as, for example, hardness, flexibility, and elasticity.

As noted, the optical fiber communicating light from the light sourcecan be introduced through an inner lumen incorporated within theelongated shaft of the balloon catheter into the expandable member toactivate the light-sensitive liquid monomer and cause it to cure. Forexample, to cure the light-sensitive fluid inside the inmost innercavity 223 of the inmost inner balloon 203, an optical fiber 106 may bepositioned either in the outmost inner cavity 219 the intermediate innercavity 221 so as to result in a cure that initiates from outside theinmost inner cavity 223 into the inmost inner cavity 223. In anembodiment, to cure the light-sensitive fluid inside the intermediateinner cavity 221, an optical fiber 106 may be positioned in the outmostinner cavity 219 so as to result in a cure that initiates from outsidethe intermediate inner cavity 221 into the intermediate inner cavity221. In an embodiment, to cure the light-sensitive fluid inside theoutmost inner cavity 219, an optical fiber 106 may be positioned in theoutmost inner cavity 219 so as to result in a cure that initiates frominside of the outmost inner cavity 219 out of the outmost inner cavity219.

Light-Sensitive Fluid

A photodynamic light-sensitive fluid may be of liquid consistency duringstorage and delivery to the expandable member, but may be cured, i.e.,solidified or hardened, by exposing the light-sensitive fluid to light,such as from the optical fiber from inside the expandable member. In anembodiment, the light-sensitive fluid is a photodynamic (light-curable)liquid monomer with photoinitiator. The light-sensitive liquid monomerwith photoinitiator is exposed to an appropriate frequency of light andintensity to cure the monomer inside the expandable member and form arigid structure. The addition of the light causes a fragmentation of thephotoinitiator, which initiates the polymerization process: monomers andoligomers join together to form a durable biocompatible crosslinkedpolymer.

In an embodiment, the light-sensitive fluid is exposed to an appropriatefrequency of light and intensity to cure the monomer inside theexpandable balloon and form a rigid structure. In an embodiment, thelight-sensitive fluid is exposed to electromagnetic spectrum that isvisible (frequency that corresponds to a band in the vicinity of 390 nmto 770 nm). In an embodiment, the light-sensitive fluid is exposed toelectromagnetic spectrum with a frequency that corresponds to a band inthe vicinity of 400 nm to 500 nm). In an embodiment, the light-sensitivefluid is radiolucent, which permit x-rays to pass through thelight-sensitive fluid. The term “cure” may refer to any chemical,physical, and/or mechanical transformation that allows a composition toprogress from a form (e.g., flowable form) that allows it to bedelivered through an inner lumen of the balloon catheter, into a morepermanent (e.g., cured) form for final use in vivo. For example,“curable” may refer to uncured composition, having the potential to becured in vivo (as by catalysis or the application of a suitable energysource), as well as to a composition in the process of curing (e.g., acomposition formed at the time of delivery by the concurrent mixing of aplurality of composition components). In an embodiment, thelight-sensitive fluid is radiolucent, which permit x-rays to passthrough the light-sensitive fluid.

In an embodiment, the viscosity of the light-sensitive fluid is fromabout 1000 cP or less. In an embodiment, the light-sensitive fluid has aviscosity ranging from about 650 cP to about 450 cP. The inflatableballoons may be inflated, trial fit and adjusted as many times as a userwants with the light-sensitive fluid, up until the light source isactivated, when the polymerization process is initiated. Because thelight-sensitive fluid has a liquid consistency and is viscous, thelight-sensitive fluid may be delivered using low pressure delivery andhigh pressure delivery is not required, but may be used. A low pressuresystem may also be adequate to deliver the light-sensitive fluid becausethe light-sensitive fluid will most often be used to inflate an innerballoon to fill in an empty space previously created by the outerballoon so there will be no or very little backpressure on thelight-sensitive fluid.

In an embodiment, the light-sensitive fluid may be provided as a unitdose. As used herein, the term “unit dose” is intended to mean aneffective amount of light-sensitive fluid adequate for a single session.By way of a non-limiting example, a unit dose of a light-sensitive fluidof the present disclosure for expanding the one or more inner balloonsmay be defined as enough light-sensitive fluid to expand the one or moreinner balloons so that the expanded one or more inner balloonssubstantially fill the space created by the outer balloon. The volume ofspace created by the outer balloon may vary somewhat from user to user.Thus, a user using a unit dose may have excess light-sensitive fluidleft over. It is desirable to provide enough light-sensitive fluid thateven the above-average user will have an effective amount of heightrestoration. In an embodiment, a unit dose of a light-sensitive fluid ofthe present disclosure is contained within a container. In anembodiment, a unit dose of a light-sensitive fluid of the presentdisclosure is contained in an ampoule. In an embodiment, a unit dose ofa light-sensitive fluid of the present disclosure is contained in asyringe. In an embodiment, the light-sensitive fluid can be deliveredunder low pressure via a syringe attached to the port. Thelight-sensitive fluid can be aspirated and re-infused as necessary,allowing for adjustments to the inmost inner balloon or the intermediateinner balloon. These properties allow a user to achieve maximum fracturereduction prior to activating a light source and converting the liquidmonomer into a hard polymer. Additives may be included in thelight-sensitive fluid and/or inflation fluid, including, but not limitedto, drugs (for example, antibiotics), proteins (for example, growthfactors) or other natural or synthetic additives (for example,radiopaque or ultrasonically active materials).

In an embodiment, an optical fiber or the present disclosure isconnected to a light source that emits frequency corresponding to a bandin the vicinity of 390 nm to 770 nm, the visible spectrum. In anembodiment, the light source emits frequency that corresponds to a bandin the vicinity of 410 nm to 500 nm. In an embodiment, the light sourceemits frequency that corresponds to a band in the vicinity of 430 nm to450 nm. The light-sensitive fluid remains a liquid monomer untilactivated by the light where the light meets the monomer and polymerizesthe monomer (cures on demand). In an embodiment, the light-sensitivefluid is exposed to an appropriate frequency of light and intensity tocure the monomer inside an expandable balloon and form a rigidstructure. In an embodiment, the light-sensitive fluid is radiolucent,which permit x-rays to pass through the liquid monomer. Radiant energyfrom the light source is absorbed and converted to chemical energy toquickly (e.g., cured in about five seconds to about five minutes)polymerize the monomer. This cure affixes an inner balloon in aninflated state.

In an embodiment, a contrast material may be added to thelight-sensitive fluid and/or inflation fluid without significantlyincreasing the viscosity. Contrast materials include, but are notlimited to, barium sulfate, tantalum, or other contrast materials knownin the art. The light-sensitive fluid can be aspirated and re-infused asnecessary, allowing for thickness adjustments to the one or more innerballoons prior to activating the light source and converting the liquidmonomer into a hard polymer. Low viscosity allows filling of the one ormore inner balloons through a very small delivery system.

In an embodiment, the light-sensitive fluid of the present disclosure isa liquid monomer with photoinitiator that has a viscosity ranging fromabout 650 cP to about 450 cP, wherein exposure to light energy having awavelength of 430 nm to 450 nm causes the light-sensitive fluid to cure.

Optical Fiber

An optical fiber uses a construction of concentric layers for opticaland mechanical advantages. The most basic function of a fiber is toguide light, i.e., to keep light concentrated over longer propagationdistances—despite the natural tendency of light beams to diverge. In thesimple case of a step-index fiber, this guidance is achieved by creatinga region with increased refractive index around the fiber axis, calledthe fiber core, which is surrounded by the cladding material. Thecladding material may be protected with a polymer coating. Light is keptin the “core” of the optical fiber by total internal reflection.Cladding keeps light traveling down the length of the fiber to adestination.

An optical fiber of the present disclosure is sized to pass through aninner lumen of the elongated shaft of the balloon catheter. In anembodiment, the optical fiber has an outer diameter ranging from about 1mm to about 4 mm. In an embodiment, the optical fiber has an outerdiameter between about 0.75 mm to about 2.0 mm. In an embodiment, theoptical fiber has an outer diameter between about 1.0 mm and about 1.5mm. The outer diameter of the optical fiber refers to the core plus thecladding plus any additional buffers or jackets that may be present.

In an optical fiber of the present disclosure, it is desirable toextract (emit) light along a given length of the optical fiber ratherthan only at the optical fiber's terminating face (distal tip). Anoptical fiber of the present disclosure includes a light-emittingportion of a given length, wherein a portion of the cladding materialfrom the light-emitting portion has been removed so that light energymay be dispersed along the length of the light-emitting portion. Thus,at least a portion of a length of the optical fiber has been modified,e.g., by removing some of the cladding material, in order to alter thedirection, propagation, amount, intensity, angle of incidence,uniformity and/or distribution of light. In an embodiment, thedispersion of light energy from the light-emitting portion occurs in aradial direction.

In an embodiment, at least a portion of a length of the optical fiberhas been modified by cutting or notching the cladding material to createthe light-emitting portion of the optical fiber. In an embodiment, thelight-emitting portion has been created by forming a helical designalong a length of the optical fiber. Such a design may be created byapplying a spiral cutter used to cut away cladding material in a helicalprofile around the optical fiber. While some embodiments may includecontinuous variations in the frequency of the cut spacing, the spiralcutter may be adaptable to vary the frequency of the spacing at discreteintervals to minimize delays during adjustment of the spacing interval.As with most linear fiber optics, as light is extracted from lengths ofthe fiber near the light source there may be less light available insubsequent lengths and this occurrence may be taken into considerationin the manufacturing process. In some embodiments, to achieve uniformlighting from the optical fiber, the frequency with which theilluminators occur may increase non-linearly in relation to the lengthof the conduit and the distance of the illuminators from the lightsource. In other words, the illuminators may be closer together as thedistance from the light source increases. This may compensate for theattenuation of the light due to the loss experienced from theilluminators and the natural attenuation of the optic itself. Thespacing may be made progressively closer or in groups of spacing inwhich the groups may progressively get closer but the distance betweenindividual illuminators within each group may remain constant. In someembodiments, the illuminators may have progressive depths to make theoptical fibers transmit light evenly along its length. When illuminatorsare made progressively deeper, the light pattern may be altered. Thedeeper the cuts, the wider the light pattern may become. Whenilluminators are made progressively closer, the light pattern may remainthe same and the light output may be increased. In some embodiments,near uniformity of light output along the length of the conduit may beachieved in part due to the changes in the spacing of the illuminatorsand in part due to the uniformity of the size and angle of theilluminators. A mechanical cutter may be well adapted to provide suchuniformity.

As illustrated in FIG. 5, for example, the helical design produces cutsat a most proximal portion of the light-emitting portion that are spreadfarther apart than cuts at a most distal portion of the light-emittingportion. Typically, when an optical fiber is attached to a light sourcethat is “on”, the cuts at the proximal portion of the light-emittingportion will emit light that looks brighter than the cuts at the distalportion of the light-emitting portion.

It is desirable to provide shape memory to the light-emitting portion ofan optical fiber of the present disclosure to create a nonlinearlight-emitting portion of the optical fiber. In some embodiments, theshape memory is imparted to the light-emitting portion usingconventional techniques known in the art. By way of a non-limitingexample, a distal length of an optical fiber of the present disclosuremay first be heat treated to provide stress relief, that is, to removeany shape memory from the optical fiber induced into the optical fiberduring the manufacturing process. Heat treatment can also be used toinduce a pre-set into the optical fiber. The distal length of thestress-relieved optical fiber may then be wound around a circularmandrel to provide the distal length with a desired shape. For example,in embodiments, the distal length of an optical fiber of the presentdisclosure may be preformed as a single loop or as multiple loops. Next,the mandrel with the coiled optical fiber can be subjected to heattreatment to induce the desired shape and then quenched to set thedesired shape into the optical fiber. In an embodiment, the opticalfiber may be heat treated using a water bath.

The nonlinear light-emitting portion can be any given length suitablefor a given application. For example, a nonlinear light-emitting portionof an optical fiber of the present disclosure can have a length rangingfrom about 100 mm to about 300 mm. In an embodiment, a system of thepresent disclosure includes a balloon catheter including inflatableballoons that have a working length that is about 15 mm shorter than thelength of the nonlinear light-emitting portion of the optical fiber. Inan embodiment, a system of the present disclosure includes a ballooncatheter including inflatable balloons that have a working length ofabout 85 mm and an optical fiber having a nonlinear light-emittingportion having a length of about 100 mm. In an embodiment, a system ofthe present disclosure includes a balloon catheter including inflatableballoons that have a working length of about 240 mm and an optical fiberhaving a nonlinear light-emitting portion having a length of about 255mm. In an embodiment, a system of the present disclosure includes aballoon catheter including inflatable balloons that have a workinglength of about 285 mm and an optical fiber having a nonlinearlight-emitting portion having a length of about 300 mm.

The illuminators may be made in optical fiber core alone before thecladding is added and/or the illuminators may be made in the claddingand the core after it has been surrounded by the cladding. In someembodiments, when the cladding is heated to tightly shrink around thecore, the cladding may affect the uniformity of the illuminators in thecore by either entering the notch or closing the cut thereby reducingthe potential light deflecting properties of the illuminator.

The illuminators may be positioned to direct light across the greaterdiameter of an elliptical optical fiber core out and out through aregion opposite from each of the respective illuminators. This may beaccomplished by angling the notches and/or cuts to direct light from thelight source through the optic core. The illuminators allow bettercontrol of escaping light by making the notches, which are positioned onone side of the optic to direct the light rather than allowing the cutsto reflect/refract light in various directions which reduces thecontribution of light to a desired focusing effect.

In an embodiment, the total light output from a nonlinear light-emittingportion of the present disclosure having a length of about 100 mm is thesame as a nonlinear light-emitting portion of the present disclosurehaving a length of about 300 mm. In an embodiment, the total lightoutput required for the nonlinear light-emitting portion of an opticalfiber of the present disclosure is about 20 μW/cm².

In some embodiments, where at least a portion of a length of the opticalfiber has been modified by cutting the cladding material, the cuts maybe made at a uniform depth of ⅛ inch into the cladding and core and at a45 degree angle from the horizontal, i.e., the longitudinal axis of theoptical fiber. This may appear to cause the light to exit perpendicularto the longitudinal axis of the optical fiber where the optical fibercore may have an acceptance angle of approximately 81 degrees to allowlight to exit. The surface of the sides of the cut may be smooth ratherthan rough to ensure light is refracted uniformly. The cut may form awedge which has a gap sufficient to prevent contact between the sides ofthe cut during normal use. Such contact may reduce the light reflectingand/or refracting properties. In some embodiments, the cuts may be lessefficient than the notches in relying on TIR to force light out of core.A holder which may fix the optical fibers in desired alignment may alsoact as a holder and/or reflector. In some embodiments, when the opticalfiber may be round in cross section and may be placed in a nonconformingholder such as a rectilinear “U” channel where an open space is createdat the bottom of the “U”, cuts may be made in the optical fibers thatcome in close proximity to the bottom of the “U” to maintain thisconfiguration. In some embodiments where a conforming holder may beused, the cuts may close and alter the configuration such thatefficiency of light extraction may be reduced. In some embodiments whenusing a conforming holder, illuminators may be made with notchessufficient to maintain an open space between the holder and notchedsurface.

In an embodiment, the nonlinear light-emitting portion includes circularsteps that have been created or cut into an optical fiber to cause thelight to disperse along each terminating face of each circular step ofthe optical fiber. In an embodiment, the nonlinear light-emittingportion is a portion that has been tapered along a length, and some ofthe cladding material has been removed. The tapering of the opticalfiber can result in a radial dispersion of light from the optical fiber.

In an embodiment, the nonlinear light-emitting portion includes notchesso as to cause the internal reflectance to be directed outwards at anangle from the notch in the optical fiber. The notch may function as anilluminator by maximizing the TIR effect of light within the core. Thismay be due to the core having a different index of refraction from theambient air in the notch which may direct the light across the core andout the opposite side of the core. Different lighting effects may beachieved by replacing the ambient air with other gases or compounds. Insome embodiments, cutting notches may include using a high speed drillmotor with a cutting blade sufficient to make a notch in the opticalfiber such that the surface created with the notch may be smooth enoughto allow total internal reflection to occur. Alignment of illuminator orilluminators with respect to the holder may determine the directionalityof the light output emitted from the optical system. The shape of thecut may effect the output beam pattern of the optical system. Forexample, the wider the cut, the wider the output beam pattern.Imperfections in the cut may direct some light into the notch. Thislight may reflect back through the core. In some embodiments, thenotches may be created at about a 45 degree angle to the fiber. In someembodiments, the notches may be created at about a 30 degree angle,about a 62.5 degree angle or any angle less than about 45 degrees orgreater than about 45 degrees as not all embodiments of the presentdisclosure are intended to be limited in this manner. Further, in someembodiments the angle of the notches may change depending on where thenotch is located along the length of the fiber. For example, an opticalfiber may be notched so that the angle of the notches which will bepositioned at the ends of the balloon have a shallower angle than thoseto be positioned at middle of the balloon.

In some embodiments, the ends of individual optical fibers that make upan optical fiber bundle may be staggered to enable light to emit fromthe light source at various locations along the length of the fiber.

In some embodiments, the optical fiber may include an optical fiber coresurrounded by cladding material and one or more illuminators. Theilluminators may be of uniform size and shape positioned in apredetermined, spaced-apart relation, linearly, along a side of theoptical fiber core. The optical fiber core may be received in a trackand/or holder and/or reflector comprising a channel constructed with areflective interior surface centered about the illuminators. The holderand/or reflector may be positioned adjacent to or in contact with theplurality of illuminators. A light source may be connected at one end ofthe optical fiber conduit in a conventional manner so as to cause a TIReffect. The end of the optical fiber conduit opposite the light sourcemay include a reflective surface for reflecting back towards the lightsource any light remaining in the optical fiber conduit. For longerspans of optical conduit, the conduit may include a second light source.

The illuminators may include any non-uniformity, constructed into theoptical fiber core during or after fabrication, that reflects orrefracts light such as, for example bubbles, prisms, lenses orreflective material formed in the core during fabrication or afterfabrication. Also, notches made from two cuts in the core to remove awedge of material or singular cuts made in the core may function as theilluminators. Illuminators, such as notches or cuts may be made by usinga mechanical cutter which may be capable of cutting the core uniformlyand leaving a smooth, texture-free surface. A cutter suitable for thispurpose may cut the core without tearing or burning the material. Acutter may have a circular disk shaped knife having a smooth, tooth-freeblade that is freely rotatable about an axle located at the center ofthe disk. The blade may be angled at 45 degrees relative to thelongitudinal axis of the core to cut a 90 degree notch wherein materialhaving a crescent or triangular shape is removed from the core.

FIG. 5 shows an embodiment of an optical fiber 106 of the presentdisclosure fabricated from a flexible light transmitting material. Theoptical fiber 106 includes a hub 150 at a proximal end for attaching toa light source (either directly or indirectly, for example, through theuse of an attachment system, see FIG. 1). The optical fiber 106 includesa linear elongated portion 148 for guiding light towards a nonlinearlight-emitting portion, generally referred to as 158, which emits lightfrom the outside of the fiber along its length. The nonlinearlight-emitting portion 158 can be any length suitable for a givenapplication. The distal tip of the optical fiber 106 may also emit lightcreating a small spotlight effect. In an embodiment, the optical fiber106 also includes a flexible strain relief 152 just to the right of thehub 150 and a depth stop 154. In an embodiment, the strain relief 152prevents snapping of the optical fiber 106 at the hub 150 junction. Inan embodiment, the strain relief 152 and the depth stop 154 are madefrom a flexible material. In an embodiment, the strain relief 152 andthe depth stop 154 are made from Santoprene™, a thermoplastic rubber.FIG. 5 shows the optical fiber 106 in an elongated stretched conditionand being in a “temporary” shape. In the temporary shape, the nonlinearlight-emitting portion 158 is stretched and assumes a linearconformation in which the nonlinear light-emitting portion 158 of theoptical fiber 106 can be advanced through the inner lumen of theelongated shaft of the balloon catheter 110.

FIG. 6, FIG. 7, FIG. 8 and FIG. 9 show various embodiments of nonlinearlight-emitting portions 158 a-d, respectively, of an optical fiber ofthe present disclosure, wherein a length of the optical fiber has beendeformed and set (fixed) to form single or multiple curved, coiledand/or convoluted shapes, wherein the nonlinear light-emitting portions158 is steerable through an inner lumen and/or an optical fiber conduitof the balloon catheter, wherein the nonlinear light-emitting portions158 is flexible so as to move from a temporary substantially straightshape confined by the walls of the inner lumen and/or optical fiberconduit and return back to its original or permanent set shape when thenonlinear light-emitting portions 158 extends beyond the lumen and/orconduit confines and into an inner cavity of a balloon of the expandablemember, and wherein the nonlinear light-emitting portions 158 ismodified by removing a portion of a cladding material surrounding thenonlinear light-emitting portions 158 to disperse light energy along thelength of the nonlinear light-emitting portions 158 so as to initiatehardening of the light-sensitive fluid within a balloon of theexpandable member.

FIG. 6 shows an embodiment of a nonlinear light-emitting portion 158 ain a relaxed condition and being in an “original”, “pre-shaped” or“permanent” shape. As illustrated in FIG. 6, in the relaxed condition,the nonlinear light-emitting portion 158 a is in a curved conformationcreating a “candy cane” or “J” shaped nonlinear light-emitting portion158. When the curved nonlinear light-emitting portion 158 a isstretched, the nonlinear light-emitting portion 158 a elongates so thatthe entire length of the optical fiber 106 has a substantially straightlongitudinal axis (see, for example, see FIG. 5). When elongated, theoptical fiber 106 can traverse and advance through the inner lumen ofthe balloon catheter 110. Once the nonlinear light-emitting portion 158a has traversed the inner lumen of the balloon catheter 110, and entersthe confines of the expandable member 103, the nonlinear light-emittingportion 158 a will return back to its original, pre-shaped, permanentshape inside the expandable member 103. The return of the nonlinearlight-emitting portion 158 a from its stretched to its relaxedcondition, is due to the memory imparted on the nonlinear light-emittingportion 158 a. The nonlinear light-emitting portion 158 a loops aroundand in close conformity to the inner wall of the inner cavity into whichit is deployed (see, for example, see FIG. 12).

FIG. 7 shows an embodiment of a nonlinear light-emitting portion 158 bin a relaxed condition and being in an “original”, “pre-shaped” or“permanent” shape. As illustrated in FIG. 7, in the relaxed condition,the nonlinear light-emitting portion 158 b is in a curved conformationcreating a “D” or “O” shaped nonlinear light-emitting portion 158 b.When the curved nonlinear light-emitting portion 158 b is stretched, thenonlinear light-emitting portion 158 b elongates so that the entirelength of the optical fiber 106 has a substantially straightlongitudinal axis (see, for example, see FIG. 5). When elongated, theoptical fiber 106 can traverse and advance through the inner lumen ofthe balloon catheter 110. Once the nonlinear light-emitting portion 158b has traversed the inner lumen of the balloon catheter 110, and entersthe confines of the expandable member 103, the nonlinear light-emittingportion 158 b will return back to its original, pre-shaped, permanentshape inside the expandable member 103. The return of the nonlinearlight-emitting portion 158 b from its stretched to its relaxedcondition, is due to the memory imparted on the nonlinear light-emittingportion 158 b. The nonlinear light-emitting portion 158 b loops aroundand in close conformity to the inner wall of the inner cavity into whichit is deployed.

FIG. 8 shows an embodiment of a nonlinear light-emitting portion 158 cin a relaxed condition and being in an “original”, “pre-shaped” or“permanent” shape. As illustrated in FIG. 8, in the relaxed condition,the nonlinear light-emitting portion 158 c is in a curved conformationcreating a “coiled” shaped nonlinear light-emitting portion 158 c. Whenthe coiled nonlinear light-emitting portion 158 c is stretched, thenonlinear light-emitting portion 158 c elongates so that the entirelength of the optical fiber 106 has a substantially straightlongitudinal axis (see, for example, see FIG. 5). When elongated, theoptical fiber 106 can traverse the inner lumen of the balloon catheter110. Once the nonlinear light-emitting portion 158 c has traversed theinner lumen of the balloon catheter 110, and enters the confines of theexpandable member 103, the nonlinear light-emitting portion 158 c willreturn back to its original, pre-shaped, permanent shape inside theexpandable member 103. The return of the nonlinear light-emittingportion 158 c from its stretched to its relaxed condition, is due to thememory imparted on the nonlinear light-emitting portion 158 c. Thenonlinear light-emitting portion 158 c loops around and in closeconformity to the inner wall of the inner cavity into which it isdeployed.

FIG. 9 shows an embodiment of a nonlinear light-emitting portion 158 din a relaxed condition and being in an “original”, “pre-shaped” or“permanent” shape. As illustrated in FIG. 9, in the relaxed condition,the nonlinear light-emitting portion 158 d is in a curved conformationcreate a “coiled convoluted” shaped light-emitting portion 158 d, havingnumerous coils or folds. When the convoluted nonlinear light-emittingportion 158 d is stretched, the nonlinear light-emitting portion 158 delongates so that the entire length of the optical fiber 106 has asubstantially straight longitudinal axis (see, for example, see FIG. 5).When elongated, the optical fiber 106 can traverse the inner lumen ofthe balloon catheter 110. Once the nonlinear light-emitting portion 158d has traversed the inner lumen of the balloon catheter 110, and entersthe confines of the expandable member 103, the nonlinear light-emittingportion 158 d will return back to its original, pre-shaped, permanentshape inside the expandable member 103. The return of the nonlinearlight-emitting portion 158 d from its stretched to its relaxedcondition, is due to the memory imparted on the nonlinear light-emittingportion 158 d. The nonlinear light-emitting portion 158 d loops aroundand in close conformity to the inner wall of the inner cavity into whichit is deployed (see, for example, see FIG. 13).

In an embodiment, an optical fiber of the present disclosure ismanufactured from a Lumenyte STA-FLEX® “SEL” END LIGHT OPTICAL FIBER,available from Lumenyte International Corporation of Foothill Ranch,Calif., can be employed. These optical fibers may each consist of alight transmitting solid large core, a Teflon® clad and a black bondableouter jacket. The optical fiber may transmit light from a light sourceto the distal tip for use as a point source. The optical fiber may havea wide 80 degree acceptance angle and 80 degree beam spread, allowingthe light to be viewed from more oblique angles. The light transmittingcore may be solid, may have no light diminishing packing fraction lossesand may be easily spliced. The jacket may be bondable. Custom jacketsmay be available for more flexibility and color options. The opticalfiber can each have a transmission loss (attenuation) of less thanapproximately 1.5% per foot, a bend radius (minimum) of approximately 6times the fiber's diameter, temperature stability of up to approximately90° C. (194° F.), spectral transmission range of approximately 350-800nm, an acceptance angle of approximately 80°, a refractive index core ofapproximately 1.48 or greater, cladding of approximately 1.34 or lessand a numerical aperture of approximately 0.63. The length of theoptical fiber can be approximately 100 continuous feet. Splicing may beachieved in the field using a splice kit, such as the Lumenyte SpliceKit, and carefully following the instructions. Factory splicing may bean option. An optic cutter, such as Lumenyte's Optic Cutter, may beadvised for straight, clean, 90° fiber cuts. These fibers may beinstalled by removing approximately 4 inches (10 cm) of the outer jacket(not the fluoropolymer cladding) before inserting fiber into the lightsource. An end of the fiber may be near, but not touching theilluminator (light source) glass to assist in achieving maximumbrightness.

In an embodiment, an optical fiber of the present disclosure ismanufactured from a ESKA™ High-performance Plastic Optical Fiber: SK-10and SK-60 and/or ESKA™ Plastic Fiber Optic & Cable Wiring, manufacturedby Mitsubishi Rayon Co., Ltd., which are all available from MitsubishiInternational Corporation of New York, N.Y. These optical fibers mayeach consist of a light transmitting PMMA (polymethylmethacrylate) coreand a fluorinated polymer as the cladding. It should be appreciated thatthe above-described characteristics and properties of the optical fibersare exemplary and not all embodiments of the present invention areintended to be limited in these respects.

In some embodiments, optical elements may be oriented in alignment withthe notches, cuts or openings in the nonlinear light-emitting portion ofan optical fiber of the present disclosure to adjust the light output.Such optical elements may include lenses, prisms, filters, spliters,diffusers and/or holographic films. The light source, and morespecifically, the optical fibers may have some or all of the propertiesand features listed in U.S. Pat. No. 6,289,150, which is herebyincorporated by reference in its entirety, as not all embodiments of thepresent invention are intended to be limited in these respects.

One or more optical elements, such as diffusers, polarizers, magnifyinglenses, prisms, holograms or any other element capable of modifying thedirection, quantity or quality of the illumination, individually or incombination can also be added and aligned with the core-clad, notchesand track or holder and/or reflector. The optical elements may be formedas separate components or formed integrally with the core, claddingand/or a jacketing material or in any combination of separate andintegrally formed components. Optical elements formed integrally in thecore and cladding of various shapes may create a lens and therebyaffects the directionality of light from the finished product. Differentoptical fiber shapes may create different output beam patterns. In someembodiments, a round fiber optic may create a wider beam spread oflight. In some embodiments, a wedge shaped optic may produce acollimated light beam spread. This beam spread may be due to what isbelieved to be a lensing effect. In some embodiments, the depth of thecut may at least intersect the focal point of the lens formed by thecurvature of the optical fiber core where the light exits the core.

The optical fiber core may have any shape and the shape of the core mayeffect the diffusion of light. In some embodiments, the optical fibercore may be cylindrically shaped when viewed in cross-section and mayform a lens that diffuses the light over a wide field of illumination.In some embodiments, the optical fiber core may have an oval orelliptical shape when viewed in cross-section and may form a lens thatincreases the intensity of the light within a narrower field ofillumination. In some embodiments, the optical fiber core may have awedge shape when viewed in a cross-section and may forms a lens. It willbe appreciated that other shapes may be used because of their desiredoptical characteristics to also act as optical elements, as not allembodiments of the present invention are intended to be limited in thisrespect.

Alternative optical elements may also assist in achieving variouslighting effects by including a separate optical element in alignmentwith the holder and/or reflector and the arc formed by the notch on theopposite side of the optic from the optical element. The lens optic,notch and holder and/or reflector may be aligned to direct light out ofthe optic and into the lens. The optical element may also be formedintegrally in the jacketing material. The jacket thickness may beadjusted to achieve a desired lighting effect. Alternatively,cylindrically shaped diffusers may be included and aligned to generateother desired lighting effects. In some embodiments, a first diffusermay lower the intensity of light passing through an optical fiber and asecond diffuser may increase the intensity of light passing through it.The two diffusers as thus described, may modify the intensity of lightas it transmits and diverges away from the optical fiber.

In order to best make use of this kind of application specific opticallighting, it may be advisable to control the alignment of theilluminators, holder and/or reflectors and optical elements. In someembodiments, the alignment of these elements may be centered about adiameter of the fiber optic core (e.g., the diameter from andperpendicular to the center of the holder and/or reflector). It may bedesirable to maintain control of this alignment along the entire lengthof the optical fiber conduit.

An optical fiber of the present disclosure can be made from anymaterial, such as glass, silicon, silica glass, quartz, sapphire,plastic, combinations of materials, or any other material, and may haveany diameter. In an embodiment, the optical fiber is made from silicaglass and may have wide-angle light dispersion of about 88 degrees. Inan embodiment, the optical fiber is made from a plastic material. In anembodiment, the optical fiber is steerable to enable the optical fiberto be maneuvered through the balloon catheter to the expandable member.The optical fiber is flexible and malleable to be maneuverable through adevice of the present disclosure. In an embodiment, the optical fiber isshapeable and/or bendable in all directions.

The core of the optical fiber may have any shape and the shape of thecore may effect the diffusion of light. In some embodiments, the core ofthe optical fiber may be cylindrically shaped when viewed incross-section and may form a lens that diffuses the light over a widefield of illumination. In some embodiments, the core of the opticalfiber may have an oval or elliptical shape when viewed in cross-sectionand may form a lens that increases the intensity of the light within anarrower field of illumination. In some embodiments, the core of theoptical fiber may have a wedge shape when viewed in a cross-section andmay forms a lens. It will be appreciated that other shapes may be usedbecause of their desired optical characteristics to also act as opticalelements, as not all embodiments of the present invention are intendedto be limited in this respect.

In an embodiment, the optical fiber emits light radially in a uniformmanner along a length of the nonlinear light-emitting portion of theoptical fiber in addition to or instead of emitting light from itsterminal end/tip. In an embodiment, the manner in which thelight-sensitive fluid is expected to be illuminated may be modeled inaccordance with Snell's law, taking into account the shape of the distalportion of the optical fiber, angles of incidence of light from theoptical fiber, refractive indexes of the inflation fluid, balloon walls,and light-sensitive fluid. In an embodiment, the optical fiber isconfigured to exude light along at least a portion of the pre-shapednonlinear light-emitting portion of the optical fiber. In anotherembodiment, the optical fiber is configured to exude light along theentire length of the pre-shaped nonlinear light-emitting portion of theoptical fiber. To that end, all or part of the cladding material alongthe pre-shaped nonlinear light-emitting portion of the optical fiber maybe removed. It should be noted that the term “removing cladding”includes taking away the cladding material entirely to expose theoptical fiber as well as reducing the thickness of the claddingmaterial. In addition, the term “removing cladding” includes forming anopening, such as a cut, a notch, or a hole, through the claddingmaterial. In an embodiment, removing all or part of the claddingmaterial may alter the propagation of light along the optical fiber. Inanother embodiment, removing all or part of the cladding material mayalter the direction and angle of incidence of light exuded from theoptical fiber. In yet another embodiment, removing all or part of thecladding material along the pre-shaped nonlinear light-emitting portionof the optical fiber may alter the intensity of light exuded from thepre-shaped nonlinear light-emitting portion of the optical fiber. In anembodiments, removing all or part of the cladding material along thepre-shaped nonlinear light-emitting portion of the optical fiber mayalter the amount of light exuded from the pre-shaped nonlinearlight-emitting portion of the optical fiber. In an embodiments, removingall or part of the cladding material along the pre-shaped nonlinearlight-emitting portion of the optical fiber may alter the incidence oflight exuded from the pre-shaped nonlinear light-emitting portion of theoptical fiber. In an embodiments, removing all or part of the claddingmaterial along the pre-shaped nonlinear light-emitting portion of theoptical fiber may alter the uniformity and/or distribution of lightexuded from the pre-shaped nonlinear light-emitting portion of theoptical fiber.

The nonlinear light-emitting portion of an optical fiber of the presentdisclosure is straight during advancement through the elongated shaft ofthe balloon catheter into the expandable member. However, once insidethe expandable member, because the nonlinear light-emitting portion ofthe optical fiber is pre-shaped and imparted with memory, the nonlinearlight-emitting portion of the optical fiber can return to a relaxedcondition in which the nonlinear light-emitting portion of the opticalfiber assumes a curved conformation. In an embodiment, the nonlinearlight-emitting portion of the optical fiber curves around the outer wallof the inner balloon. In an embodiment, the nonlinear light-emittingportion of the optical fiber curves around the outer wall of the innerballoon in a separate optical fiber conduit. In an embodiment, thenonlinear light-emitting portion of the optical fiber curves inside theinner wall of the inner balloon. In an embodiment, the nonlinearlight-emitting portion of the optical curves inside the inner wall ofthe inner balloon in a separate optical fiber conduit. In an embodiment,the nonlinear light-emitting portion of the optical fiber curves, loopsand/or coils inside the cavity of the inner balloon. Once the opticalfiber is deployed in the expandable member, the light source may beactivated so the light from the optical fiber illuminates alight-sensitive fluid contained in the inner balloon, causing the lightsensitive fluid to cure. Because of the shape of the nonlinearlight-emitting portion, and the removal of at least a portion ofcladding material along the length of the nonlinear light-emittingportion, the optical fiber can exude light radially in a uniform manner,so the light is evenly dispersed. In an embodiment, the light is evenlydispersed from outside the inner balloon towards the inside of the innerballoon to cure the light-sensitive fluid contained therein. In anembodiment, the light is evenly dispersed from inside the inner balloontoward the outside of the inner balloon to cure the light-sensitivefluid contained therein. Due to its shape, the nonlinear light-emittingportion illuminates the light-sensitive fluid in a substantiallycircumferential manner. Also, because the nonlinear light-emittingportion is flexible and has shape memory it can continue to stay inconformance with the walls of the balloon even if the shape or size ofthe balloon changes during the curing step. Moreover, due to its shape,the nonlinear light-emitting portion may also serve to move the outerballoon from a deflated state to an inflated state or to support theouter balloon in an inflated state.

In some embodiments, the intensity of light may be sufficient enough toreach the distal end of the expandable member if the optical fiber isheld in close proximity to or contacting/abutting the expandable member.By knowing the energy required to cure the light-sensitive fluid andcalculating the distance from the optical fiber to the most distalaspect of the expandable member, the inverse square law may be used tocalculate how much energy will dissipate over the distance and thereforewhether the optical fiber can be abutted to the expandable member orneed be placed within the expandable member so that it is closer to thelight-sensitive fluid. Not only is the distance from the optical fiberto the light-sensitive fluid reduced by placing the optical fiber insidethe expandable member, but the overall necessary intensity of light maybe reduced.

FIG. 10 shows a close-up view of an embodiment of a distal end of aballoon catheter of the present disclosure. The distal end of theballoon catheter includes expandable member 103, which comprises anouter inflatable balloon 301 and an inner inflatable balloon 303. Theballoon catheter includes an elongated shaft having a first inner lumen311 in fluid communication with the outer expandable balloon 301, asecond inner lumen 313 in fluid communication with the inner expandableballoon 303. In addition, a separate optical fiber conduit 206 isincorporated within the elongated shaft of the balloon catheter andencircles the outer surface of the inner expandable balloon 303 toseparate the optical fiber from other components of the ballooncatheter, allowing the optical fiber to be removed from the ballooncatheter after curing the light-sensitive fluid. In an embodiment, theoptical fiber conduit 206 is fabricated from a thin walled PET tube.

FIG. 11 shows a close-up view of an embodiment of a distal end of aballoon catheter of the present disclosure. The distal end of theballoon catheter includes expandable member 103, which comprises anouter expandable balloon 401 and an inner expandable balloon 403. Theballoon catheter includes an elongated shaft having a first inner lumen411 in fluid communication with the outer expandable balloon 401, asecond inner lumen 413 in fluid communication with the inner expandableballoon 403. In addition, a separate optical fiber conduit 206 isincorporated within the elongated shaft of the balloon catheter andencircles the inner surface of the inner expandable balloon 403 toseparate the optical fiber from other components of the ballooncatheter, allowing the optical fiber to be removed from the ballooncatheter after curing the light-sensitive fluid. In an embodiment, theoptical fiber conduit 206 is fabricated from a thin walled PET tube.

FIG. 12 shows a close-up view of an embodiment of a distal end of aballoon catheter of the present disclosure. The distal end of theballoon catheter includes expandable member 103, which comprises anouter expandable balloon 501 and an inner expandable balloon 503. Theballoon catheter includes an elongated shaft having a first inner lumen511 in fluid communication with the outer expandable balloon 501, asecond inner lumen 513 in fluid communication with the inner expandableballoon 503. The nonlinear light-emitting portion 158 a of the opticalfiber returns from the stretched condition, in which the nonlinearlight-emitting portion 158 a has a linear conformation for advancingthrough the second inner lumen 513 of the elongated shaft 110 of theballoon catheter, to the relaxed condition, in which the nonlinearlight-emitting portion 158 a assumes the curved conformation, whenreleased into the inner expandable balloon 503.

FIG. 13 shows a close-up view of an embodiment of a distal end of aballoon catheter of the present disclosure. The distal end of theballoon catheter includes expandable member 103, which comprises anouter expandable balloon 601 and an inner expandable balloon 603. Theballoon catheter includes an elongated shaft having a first inner lumen611 in fluid communication with the outer expandable balloon 601, asecond inner lumen 613 in fluid communication with the inner expandableballoon 603. The nonlinear light-emitting portion 158 d of the opticalfiber returns from the stretched condition, in which the nonlinearlight-emitting portion 158 d has a linear conformation for advancingthrough the second inner lumen 613 of the elongated shaft 110 of theballoon catheter, to the relaxed condition, in which the nonlinearlight-emitting portion 158 d assumes the coiled convoluted conformation,when released into the inner expandable balloon 603.

FIGS. 14A-14E illustrate an embodiment of the method steps for repairinga vertebral compression fracture using components of the presentdisclosure. In an embodiment, the method relieves the pain of brokenvertebrae and restores height to a hunched-over patient. To that end, aminimally invasive incision (not shown) may be made through the skin ofthe patient's body near the spine and a cannula (not shown) may beinserted percutaneously into a cancellous bone region 701 of a collapsedor fractured vertebra 703, for example via the left or right pedicle ofthe vertebra. The cannula may be any type and size of hollow cannula,preferably having a sharp end.

Next, a balloon catheter 110 of the present disclosure may be advancedthrough the cannula to position the expandable member 103, with theplurality of balloons 201, 203, 205 in an unexpanded, deflated state, inthe cancellous bone region 701 of the collapsed or fractured vertebra703, as illustrated in FIG. 14A. In an embodiment, the expandable member103 is delivered to the spine by the flexible balloon catheter 110 fromthe posterior aspect of a patient. During insertion of the expandablemember 103 into the collapsed or fractured vertebra 703, the location ofthe expandable member 103 may be monitored using visualization equipmentsuch as real-time X-Ray, CT scanning equipment, MM, or any othercommonly used monitoring equipment. Once the expandable member 103 ispositioned within the collapsed or fractured vertebra 703, an inflationfluid 705 may be injected into the outmost inner cavity 219 to move theouter balloon 201 from a deflated state to an inflated state, as shownin FIG. 14B. In an embodiment, the inflation fluid 705 is water orsaline. In an embodiment, the inflation fluid 705 is air. As the outerballoon 201 moves from a deflated state to an inflated state, the outerballoon 201 expands the collapsed or fractured vertebra 703 so as toachieve controlled distraction and height restoration. An optical fiber106 of the present disclosure may be inserted into the expandable member103 before or after the outmost inner cavity is filled with theinflation fluid 705.

Additionally or alternatively, the balloons may be moved from a deflatedstate to an inflated state by inserting the pre-shaped optical fiber 106into one or more inner cavities within the balloon. To move a balloonfrom an inflated state to a deflated state the inflation fluid, and, ifapplicable, the optical fiber, may be withdrawn from one or more innercavities within the balloon.

In an embodiment, the balloons of the expandable member 103 may beconfigured so that in operation the balloons can only expand in avertical direction to affect the height of the vertebra, but not in ahorizontal direction to avoid exerting undue pressure on the side wallsof the vertebra. In an embodiment, to achieve this goal, the side wallsof the balloons may be reinforced or made of a stronger material thanthe top and bottom sides of the balloons.

Once the collapsed or fractured vertebra 703 is expanded to a desiredheight and distraction, the inmost inner balloon 203 may be moved from adeflated state to an inflated state by infusing a light-sensitive fluid707 into the inmost inner cavity 223. It should be noted that it may bedesirable, in an embodiment, to distract the collapsed or fracturedvertebra 703 to a height slightly greater than the desired height toallow for subsequent compression and compaction of the space created bythe outer balloon 201 in the cancellous bone region 701 once the outerballoon 201 is deflated at the end of the procedure. The final height ofthe vertebra may be adjusted using the intermediate inner balloon 205and/or the outer balloon 201. Because the outer balloon 201 remains inthe inflated state to maintain the distraction of the vertebra, theinmost inner balloon 203 is expanded with minimal backpressure, and thusa low pressure system may be used to infuse the light-sensitive fluid707 into the inmost inner cavity 223 to inflate the inmost inner balloon203.

The light-sensitive fluid 707 in the inmost inner cavity 223 may behardened by inserting the pre-shaped optical fiber 106 into the outmostinner cavity 219, as shown in FIG. 14C, or the intermediate inner cavity221, or the inmost inner cavity 223 and activating the optical fiber 106to illuminate the light-sensitive fluid 707 in the inmost inner cavity223. As noted above, because the optical fiber 106 is pre-shaped, it canloop in conformance with the inmost inner cavity 219 and, thus provideuniform illumination of the light-sensitive fluid 707 contained in theinmost inner cavity 223 to cure the light-sensitive fluid 707 fromoutside of the inmost inner 223 cavity into the inmost inner cavity 223.During the curing step, the outer balloon 201 may remain inflated withthe inflation fluid 705 to maintain the desired height of the collapsedor fractured vertebra 703. In an embodiment, the inflation fluid 705inside the outmost inner cavity 219 acts as a cooling medium and as abarrier to any heat transfer between curing light-sensitive fluid 707and vertebral tissue 701 and surrounding spinal nerves. In anembodiment, the inflation fluid 705 may be circulated during the curingstep to ensure that the inflation fluid 705 is maintained at asubstantially constant temperature throughout the procedure. In anembodiment, a thermocouple may be used to monitor the temperature of theinflation fluid.

Once the light-sensitive fluid 707 inside the inmost inner cavity 223 iscured, the outer balloon 201 may be deflated by withdrawing theinflation fluid 705 from the outmost inner cavity 219, as shown in FIG.14D, although the step of removing the inflation fluid 705 from theoutmost inner cavity 219 is optional. If desired, the above process maybe repeated for the intermediate inner balloon 205 to adjust the heightof the collapsed or fractured vertebra 703. In an embodiment, theintermediate inner balloon 205 may be moved from a deflated state to aninflated state after the outer balloon 201 is deflated to fill in spaceinside the collapsed or fractured vertebra 703 vacated by the outerballoon 201. This enables the user to precisely adjust the collapsed orfractured vertebra 703 to the desired height. Moreover, if desired, theoutmost inner cavity 219 may also be filled with the light sensitiveliquid, which may be cured from inside out using the optical fiber 106in the outmost inner cavity. Finally, once the expandable member 103 isset, it can be separated from the balloon catheter 110, so the ballooncatheter 110 can be removed, as shown in FIG. 14E.

A device of the present disclosure may be used to replace anintervertebral disc. FIGS. 15A-15E illustrate an embodiment of themethod steps for replacing a degenerative disc 820 positioned betweentwo vertebrae 800, 810, using components of the present disclosure. Themethod includes removing the degenerative disc 820 to create a space, asillustrated in FIG. 15A, and delivering, in an unexpanded state, anexpandable member 103 having at least a first inner balloon positionedinside and completely surrounded by an outer balloon to the space, asillustrated in FIG. 15B. Once the expandable member 103 is properlypositioned, an inflation fluid 840 is injected into the outer balloon toexpand the outer balloon and to temporarily restore native disc height,as illustrated in FIG. 15C. While maintaining the expanded outerballoon, a light-curable fluid 850 is injected into the inner balloon toexpand the inner balloon within the expanded outer balloon, asillustrated in FIG. 15D. An optical fiber 106 of the present disclosure,having any of the nonlinear light-emitting portions described herein andsufficiently designed to emit light energy along a length of the opticalfiber, is positioned inside the expandable member 103, as illustrated inFIG. 15E. The optical fiber 106 is connected to a light source (notvisible) which is activated to cure the light-curable fluid 850 insidethe inner balloon to harden the inner balloon within the expanded outerballoon. The inflation fluid 840 that was injected into the outerballoon can either remain inside the outer balloon, or can be removedfrom the outer balloon. The optical fiber 106 that was positioned withinthe expandable member 103 can either remain inside the expandable member103, or can be removed from the expandable member 103. At the end of theprocedure, the hardened expandable member 103 is removed from theballoon catheter and remains in position, thus replacing thedegenerative disc 820.

A method for repairing a vertebral compression fracture includespositioning an expandable member releasably disposed at a distal end ofa balloon catheter within a cancellous bone region of a fractured orcollapsed vertebra, wherein the expandable member comprises an outerballoon and one or more inner balloons; moving the outer balloon from adeflated state to an inflated state to expand the collapsed or fracturedvertebra to a desired height; moving one or more inner balloons from adeflated state to an inflated state with a light-sensitive fluid;introducing a pre-shaped optical fiber into an inner cavity within theouter balloon; activating the optical fiber to uniformly cure thelight-sensitive fluid within the one or more inner balloons; moving theouter balloon from the inflated state to the deflated state; andreleasing the expandable member from the balloon catheter.

A method for replacing a degenerative disc includes removing adegenerative disc to create a space; delivering, in an unexpanded state,an expandable member having a first inner balloon positioned inside andcompletely surrounded by an outer balloon to the space; injecting aninflation fluid into the outer balloon to expand the outer balloon andto temporarily restore native disc height; maintaining the expandedouter balloon while injecting a light-curable fluid into the innerballoon to expand the inner balloon within the expanded outer balloon;positioning an optical fiber sufficiently designed to emit light energyalong a length of the optical fiber inside the expandable member,wherein the optical fiber is connected to a light source; activating thelight source; delivering light energy to the optical fiber from thelight source; and curing the light-curable fluid inside the innerballoon to harden the inner balloon within the expanded outer balloon.

A method for repairing a vertebral compression fracture includes gainingaccess to a fractured area of a collapsed vertebrae; providing a ballooncatheter having an elongated shaft with a proximal end, a distal end,and a longitudinal axis therebetween, the balloon catheter comprising:at least one inner lumen incorporated within the elongated shaft; anexpandable member including an inner inflatable balloon positionedinside and completely surrounded by an outer inflatable balloon, theexpandable member located at the distal end; and a multipurpose adapterfor passage of at least one of an inflation fluid or a medicalinstrument, the multipurpose adapter located at the proximal end;positioning the expandable member, in a deflated state, in the fracturedarea of the collapsed vertebrae; injecting a first inflation fluid intothe outer inflatable balloon of the expandable member to inflate theouter inflatable balloon and temporarily restore height of the collapsedvertebrae; injecting a second light-curable inflation fluid into theinner inflatable balloon of the expandable member to inflate the innerinflatable balloon; providing a flexible optical fiber having a coresurrounded by a cladding material, the optical fiber comprising an outerdiameter sized to pass through the inner lumen of the elongated shaft ofthe balloon catheter; a nonlinear light-emitting portion of a givenlength, wherein a portion of the cladding material from the nonlinearlight-emitting portion has been removed so that light energy may bedispersed along the length of the nonlinear light-emitting portion; anda linear elongated portion for guiding light towards the nonlinearlight-emitting portion; advancing the nonlinear light-emitting portionof the optical fiber through the inner lumen of the elongated shaft ofthe balloon catheter in a stretched condition in which the nonlinearlight-emitting portion of the optical fiber has a linear conformation,and releasing the nonlinear light-emitting portion of the optical fiberinto the expandable member in a relaxed condition in which the nonlinearlight-emitting portion of the optical fiber assumes a curvedconformation; activating a light source that is connected to the opticalfiber so the nonlinear light-emitting portion of the optical fiberdisperses light energy at a terminating face and along a length of theoptical fiber to communicate light energy to cure the secondlight-curable inflation fluid; and releasing the hardened expandablemember from the balloon catheter.

A device includes a balloon catheter having an elongated shaft with aproximal end, a distal end, and a longitudinal axis therebetween, theballoon catheter comprising at least one inner lumen incorporated withinthe elongated shaft; an inner balloon positioned inside and completelysurrounded by an outer balloon, the balloons located at the distal end;and an adapter for passage of at least one of an inflation fluid or amedical instrument, the adapter located at the proximal end; and anoptical fiber having a core surrounded by a cladding material, theoptical fiber comprising an outer diameter sized to pass through theinner lumen of the elongated shaft of the balloon catheter; a nonlinearlight-emitting portion of a given length, wherein a portion of thecladding material from the nonlinear light-emitting portion has beenremoved so that light energy may be emitted along the length of thenonlinear light-emitting portion; and a linear elongated portion forguiding light towards the nonlinear light-emitting portion.

A device includes a balloon catheter having an elongated shaft with aproximal end, a distal end, and a longitudinal axis therebetween; anexpandable member releasably disposed at a distal end of the ballooncatheter, the expandable member comprising an outer balloon and one ormore inner balloons; and an optical fiber having a pre-shaped distalportion, wherein the balloon catheter includes a plurality of innerlumens in fluid communication with a plurality of inner cavities withinthe expandable member for passing the optical fiber, an inflation fluid,and a light-sensitive fluid to the plurality of inner cavities withinthe expandable member, and wherein the optical fiber is configured toemit light along at least a part of the pre-shaped distal portion of theoptical fiber.

A system includes a balloon catheter having an elongated shaft with aproximal end, a distal end, and a longitudinal axis therebetween, theballoon catheter comprising at least one inner lumen incorporated withinthe elongated shaft; at least a first inner inflatable balloonpositioned inside and completely surrounded by an outer inflatableballoon, the balloons located at the distal end; and an adapter forpassage of at least one of an inflation fluid or a medical instrument,the adapter located at the proximal end; an optical fiber having a coresurrounded by a cladding material, the optical fiber comprising an outerdiameter sized to pass through the inner lumen of the elongated shaft ofthe balloon catheter; a nonlinear light-emitting portion of a givenlength, wherein a portion of the cladding material from the nonlinearlight-emitting portion has been removed so that light energy may beemitted along the length of the nonlinear light-emitting portion; alinear elongated portion for guiding light towards the nonlinearlight-emitting portion; a relaxed condition in which the nonlinearlight-emitting portion of the optical fiber assumes a curvedconformation; a stretched condition in which the nonlinearlight-emitting portion of the optical fiber has a linear conformation inwhich the nonlinear light-emitting portion of the optical fiber can beadvanced through the inner lumen of the elongated shaft of the ballooncatheter; and a memory which returns the nonlinear light-emittingportion from the stretched condition to the relaxed condition; alight-sensitive fluid; and a light source.

All patents, patent applications, and published references cited hereinare hereby incorporated by reference in their entirety. It will beappreciated that several of the above-disclosed and other features andfunctions, or alternatives thereof, may be desirably combined into manyother different systems or applications.

What is claimed is:
 1. A device comprising: a balloon catheter having anelongated shaft with a proximal end, a distal end, and a longitudinalaxis therebetween, the balloon catheter comprising: a balloon located atthe distal end of the balloon catheter; an optical fiber comprising anonlinear light-emitting portion configured to emit light energy along alength of the nonlinear light-emitting portion; and a linear elongatedportion for guiding light towards the nonlinear light-emitting portion,wherein the optical fiber has a linear conformation in which thenonlinear light-emitting portion of the optical fiber can be advancedthrough the elongated shaft of the balloon catheter into the balloon anda curved conformation in which the nonlinear light-emitting portion ofthe optical fiber can curve inside the balloon, wherein the nonlinearlight-emitting portion includes a plurality of spaced apart cuts in acladding material along a length of the nonlinear light-emitting portionexposing a core, and wherein spaces between the cuts decrease toward adistal end of the optical fiber to harden a light-sensitive fluid in asubstantially circumferential uniform light intensity when the opticalfiber is in the curved conformation.
 2. The device of claim 1 whereinthe balloon catheter has an outside diameter ranging from about 3 mm toabout 8 mm.
 3. The device of claim 1 wherein the optical fiber has anoutside diameter ranging from about 0.75 mm to about 2.0 mm.
 4. Thedevice of claim 1 wherein the balloon has a toroidal shape.
 5. Thedevice of claim 1 wherein the optical fiber further comprises: a relaxedcondition in which the nonlinear light-emitting portion of the opticalfiber assumes the curved conformation; a stretched condition in whichthe nonlinear light-emitting portion of the optical fiber assumes thelinear conformation; and a memory which returns the nonlinearlight-emitting portion from the stretched condition to the relaxedcondition.
 6. The device of claim 5 wherein the curved conformation ofthe nonlinear light-emitting portion forms a candy cane shape.
 7. Thedevice of claim 5 wherein the curved conformation of the nonlinearlight-emitting portion forms a U shape.
 8. The device of claim 5 whereinthe curved conformation of the nonlinear light-emitting portion forms acoiled shape having multiple loops.
 9. The device of claim 5 wherein thecurved conformation of the nonlinear light-emitting portion forms aconvoluted shape.
 10. The device of claim 5 wherein the cuts in thecladding material form a helical design along a length of the opticalfiber.
 11. A system for treatment of an intervertebral disc comprising:a balloon catheter having an elongated shaft with a proximal end, adistal end, and a longitudinal axis therebetween, the balloon cathetercomprising: a balloon located at the distal end of the balloon catheter;an optical fiber having a core surrounded by a cladding material, theoptical fiber comprising a nonlinear light-emitting portion configuredto emit light energy along a length of the nonlinear light-emittingportion and a linear elongated portion for guiding light towards thenonlinear light-emitting portion; wherein, the optical fiber has arelaxed condition in which the nonlinear light-emitting portion of theoptical fiber assumes a curved conformation, in which the nonlinearlight-emitting portion of the optical fiber curves inside the balloonand has a stretched condition in which the nonlinear light-emittingportion of the optical fiber has a linear conformation in which thenonlinear light-emitting portion of the optical fiber can be advancedthrough an inner lumen of the elongated shaft of the balloon catheter,wherein the nonlinear light-emitting portion includes a plurality ofspaced apart cuts in the cladding material along a length of thenonlinear light-emitting portion exposing the core, and wherein spacesbetween the cuts decrease toward a distal end of the optical fiber toharden the light-sensitive fluid in a substantially circumferentialuniform light intensity when the optical fiber is in the curvedconformation; a light-sensitive fluid; and a light source.
 12. Thesystem of claim 11 further comprising at least one inner balloon,wherein the at least one inner balloon and the balloon are concentricrelative to one another.
 13. The system of claim 11 wherein the curvedconformation of the nonlinear light-emitting portion forms one of acandy cane shape, a U shape or a coiled shape having multiple loops. 14.The system of claim 11 wherein the light-sensitive fluid has a viscosityranging from about 650 cP to about 450 cP.
 15. The system of claim 11wherein the cuts in the cladding material form a helical design along alength of the optical fiber.
 16. A method for repairing a vertebralcompression fracture comprising: gaining access to a collapsedvertebrae; delivering to the collapsed vertebrae, in an unexpandedstate, an expandable member; injecting a light-curable fluid into theexpandable member; positioning an optical fiber along a length insidethe expandable member, wherein the optical fiber is connected to a lightsource and is configured to emit light energy; delivering light energyto the optical fiber from the light source; and curing the light-curablefluid inside the expandable member to harden the light-curable fluid.17. The method of claim 16 further comprising: injecting an inflationfluid into an outer expandable member to expand the outer expandablemember and to temporarily restore height of the collapsed vertebrae; andremoving the inflation fluid from the outer expendable member aftercuring the light-curable fluid inside the expandable member.